Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036053564 | IL |
N | 2086X0206X | Surgical Oncologist | 036053564 | IL |
NPI | 1174502843 |
---|---|
Provider Name | Dr. Steven Gitelis |
First Address | Westchester, IL 60154-5701 |
Second Address | Chicago, IL 60612-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 09/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036053564 1 | (05) | IL |
1633878 | BCBS GROUP ID# (01) | IL |
207067 | MEDICARE PTAN LOCALITY 16 (01) | IL |
207073 | MEDICARE PTAN LOCALITY 15 (01) | IL |
4028614 | AETNA ID# (01) | IL |
C41867 | (02) | IL |
DA4902 | RR MEDICARE PTAN# (01) | IL |
P00231217 | RR MEDICARE ID# (01) | IL |